Aging Voice Problems

Presbyphonia, Presbylaryngeus

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Voice problems -- such as voice weakness -- that develop with age can affect you socially and emotionally, possibly even leading to isolation and depression. Duke voice specialists use the latest techniques and bring years of experience to evaluating your voice problem and helping make your voice stronger so you can stay engaged in all the things you love to do.

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Duke Health offers locations throughout the Triangle. Find one near you.

Voice Problems as We Age

As we get older, our voices change. Some of this stems from other aging-related processes: we lose muscle mass, our mucous membranes thin and become drier, our lung capacity lessens, and we lose some of our fine muscle coordination. Changes can also occur in the voice box, such as vocal cord (also known as vocal fold) atrophy or bowing (presbyphonia or presbylaryngeus).

Changes in the voice as we age can include:

  • Reduced volume or projection of the voice
  • Reduced vocal stamina
  • Voice weakness
  • Higher pitch in men
  • Lower pitch in women
  • Tremor or shakiness of the voice

A voice evaluation can clarify your diagnosis and determine the best treatment for your condition. 


Comprehensive Evaluation

We will assess your voice use patterns -- how much you speak, sing, or use a loud voice, and what your voice sounds like. Your laryngologist will evaluate the role of any medical conditions that can cause voice changes, such as surgeries or recent illness. We will perform a head and neck examination and a visual examination of your larynx (voice box).


This detailed visual exam helps us evaluate how your vocal cords vibrate while you speak or sing. A tiny camera attached to a small tube called an endoscope is inserted through your nose and allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow motion video images of your vocal cords. The exam takes only about a minute, and your nose may be sprayed with topical anesthetic for your comfort. 

The exam allows our team to look for lesions, stiffness, paralysis, irregular movements, throat strain, incomplete closure of the vocal cords due to thinning, or other physical contributors to your voice problem. After the exam, our team will review the images with you. Videolaryngostroboscopy is essential to reaching an accurate diagnosis and determining the best treatment for your voice.

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There are many options available to improve your vocal quality and stamina.

Voice Therapy

Voice therapy helps you learn to reduce muscle tension in the throat, use your breath to power your voice, and use good oral resonance (how air flows through your mouth and nose when you speak). You'll work with a speech pathologist who will guide you through vocal exercises to improve breathing, reduce throat strain, and find your optimal pitch and volume for strong, healthy speaking.

Temporary Vocal Cord Augmentation

Injectable fillers add bulk to vocal cords that have lost muscle tone due to aging or vocal cord paralysis. The material is injected using a tiny needle inserted into the area next to one or both vocal cords. The injection helps the vocal cords close better, creating a stronger, clearer voice. This can be done in the operating room under general anesthesia or during an office visit with topical numbing to the area. The fillers are reabsorbed by your body over time.


An implant (like a tiny shim) is placed through the voice box to permanently reposition your vocal cord to achieve better closure during speech, which results in a stronger voice. This procedure requires a small incision in the neck and is performed in the operating room using heavy but not complete sedation. This is so you can respond to the surgeon to ensure optimal placement of the implant. After that, you will be asleep under general anesthesia while the surgeon completes the procedure.

Why Choose Duke

Comprehensive Care
We are one of only a few centers in the Southeast offering comprehensive care for voice problems in older adults. We work with other specialists to manage any medical conditions that affect your voice.

Team of Specialists
Your care team will include laryngologists -- ear, nose, and throat (ENT) doctors with advanced training in voice problems -- and speech pathologists who specialize in treating voice problems in older adults.

Expert Diagnosis
You'll benefit from a comprehensive voice evaluation that looks into all the factors that may be contributing to your voice problem. These include medical conditions, medications, the way you use your voice, as well as your age. 

Latest Treatments
Our laryngologists are trained in the most advanced techniques in voice surgery, whether it's vocal cord augmentation (enhancing the vocal cords for a better sound) or microsurgery to remove vocal cord lesions.

Specialty Care for Singers and Professional Voice Performers
If you sing, whether professionally or for personal enjoyment, you can consult with our clinical singing voice specialists -- speech pathologists who are also experienced singers and singing teachers. They are trained to work with the whole age range of voices and are skilled in treating the special problems that develop with the singing voice as we age.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

This page was medically reviewed on 11/08/2022 by